NAIROBI, 29 March 2010 (PlusNews) – A cheap, widely available antibiotic given to patients when they start taking life-prolonging antiretroviral (ARV) drugs could reduce HIV mortality in resource-limited settings by up to 50 percent says a new study published in the scientific journal, The Lancet.
“We studied patients who were starting HIV treatment and found that in the group that took co-trimoxazole alongside ARVs, mortality was half what it was in the group which started on ARVs alone,” Prof Diana Gibb, of the United Kingdom’s Medical Research Council (MRC), a co-author of the study, told IRIN/PlusNews.
“We know that ARVs on their own reduce HIV mortality by as much as 90 percent; what our study found was that the use of co-trimoxazole reduces it further still.”
The observational study analyzed 3,179 Ugandan and Zimbabwean participants from the Development of Anti-Retroviral Therapy in Africa (DART) trial, conducted by the MRC in Uganda and Zimbabwe, for almost five years. All participants had a CD4 count – a measure of immune strength – of below 200 at the start of the study.
The United Nations World Health Organization recommends co-trimoxazole prophylaxis for all HIV-infected patients with a CD4 count below 350, particularly in resource-limited settings where bacterial infections and malaria are commonplace in HIV-positive people.
Despite these guidelines, the DART study found that the use of the antibiotic was inconsistent in Uganda and Zimbabwe, usually “initiated or continued at discretion of the treating clinician”.
“Co-trimoxazole is very low-cost, it’s generic and manufactured locally in many African countries, so it is widely available and is already in wide use as a treatment for infections such as pneumonia,” Gibb said. “It’s a pill a day – just a few [United States] cents.”
A 2008 study among HIV-infected children in Zambia found co-trimoxazole prophylaxis “highly cost-effective”.
Other than a small number of patients developing a rash, Gibb said, there were hardly any side effects. An added benefit of using the antibiotic was a reduced frequency of malaria, which is endemic in Uganda.
The study recommended co-trimoxazole prophylaxis for at least 72 weeks in all adults starting combination ARVs in Africa.
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